05-106118 • � ��c�i�v 1 �\/) �(fJ�
� CITY OF�rti/ Y� � — �t./ "C.. i�i��
Feder��way PERMIT
co���nEVEcorn�rvrs�rrnc�I O V �+ 9 Z D O� SF MF CO ME EL PL DE E �
33325 8"�AVEMIE SOUIH•PO BOX 9718 LI CATI O N
FEDERAL WAY,WA 98063-9718
2�-s��-zso�•F'ix a�a�S�Y O F FE D E R L A / /
wu+w.cityoffederalu�au.ro BUILDING pEPT,
The olLmyi is tred ormallon-an lete licallon wtU not be ted. Please t (itt ink)or
•• •� •
SITE ADDRE.S8 ` G SIIITE/UNIT�
ASSESSOR'S TA%/PARCEI.# — — — — — — — — — — I'pT g�Zg�S�
LEGlIL DESCRIPTION(e.g.Acme Esta#es,Lot 1)
uuacn sep�ate aoseJa.�r�h+�legal desvqtluo
'• •' •
1RP'E OF PERMIT ❑BUILDING ❑ PWMBII�iG ❑ MF.CHANICAI.
❑ DEMOLITIOM ❑ ELECTRICAI. ❑ ENGIIITEERII�iG�FIRE PREVEMITON SYSTEM
PROJECT DF��IPTION uide detaQe cription of work on this o
� � �rP �c,�� �� , i��yll'c� �/�JC��� �'�
PROJECT NAME(Name of Business or Ou�ner Last Nam� � V L�V (� ' UGI�� l��
� • •• •
PROPERTY N� �+xr rxorrE
OWNFR ( ) -
MAII.ING ADDRESS CIlY.STA'IE,ZIP
CONTRACTOR CO � APPIlCArTf NAME OP'N7CE PHONE
��' � tJ�'.r) (3G�) �$'7 ' (1/D�
G ADD C .STA1E.Z� CEtb PHONE
� r� �1 � � ,� �r� 9�.s� �3�>>��� -3�'s
CiTY OF FEDERAL WAY BUSWFSS IlCENSE NUMBER E7�IItA'I70 DATE FAX NITMBER
.� -.��1 � J � 1_ �-B° 1 '3� '�� ��i��� -,���'
CON7RACTORS RF.GIS�A N IJijl�$$Icop�oI qrd�dth ach�PP�u�) E7�RtA�IqN DA�
/ C.� (� // /]1
� U� lJ z CI "Z ��% �"� /�F" /
�]�(,`,�1j'i` CO NAME N OFPiCE PHONE
U�v q�` � c�Q�� c �35�'I - j�o �
ADDRESS � C�IY.SfA7E.ZIP C PHONE
-�� a� ( ) 3 -
REIA170NSHIP TO PROJECT ] gpyL �
❑Architect O Tenant ❑Agent ❑ Other(DescrU�e�L�✓ CDt`1 ( )"� - �
CONTACT NAME PRIMARY PHO � E-MAQ,ADDRESS
- ( ) s'�7 -
�rmER �acw is.a�.osa: r.enaer�'m,nacton�s '�^"�
rzquined{1'�cc vatue�rceerls Ss.o00
MAD.ING ADDRESS C17Y.5fH7E.ZIP PHONE
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F.RISTII�i(�USE ! PROPOSED USE -t
�
ESIS'l�G ASSESSED/APP'RAISED VALUE $ VALUE OF PROPOSED WORH $ ��'�JS
sr�nv�x�n stm unva� ❑�s �o FIRE SIJPPRESSION BYSTEM P1tOPOSED/REgIIIItED? ❑�s r�xo
WATER SERVICE P1tOVIDER ❑ LAHEHAVEN o ffiGHI iNE ❑ TACONA ❑ PRIVATE(iVFdd.)
SEWER 8ERVICE PROVIDER ❑LAHEHAVEN O ffiGHI.iNE ❑ PRIVATE(SEPTIC)
•. .
AREA DESCRIPTIOli FXISTIIV(3 PROPOSED TOTAL
.FT. .FT. .FT.
BASEMENT
FIRST
SECOND
1��IRD
FOUR71-�
ADDT770NAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE O CARPORT❑
NUMBER OF FLOORS �m rnoro� rarei. mrecmraras mreusaaen�s rarei.a
•'NEW HOME.S ONLY" NUMBER OF BEDROOMS FSIIMATED SELIdNG PRICE $
Indicate nwnber of each hJPe o.fJ�lure tn be installed or relocated as part of this project Do not fnclude exLsting J&h�res tn remain.
A2�HAlVICAL
Value of Mechanical Work $
AIR HANDIdNG UNPIS E\7APORATNE C001,ERS GAS I.OGS REFRIG.SYSTEMS
BBQS FANS HOODS�comme,c�l) WOODSfOVES
BOILERS FIREPIACE INSERTS RANGES MISC(Descrlbe)
COMPRESSORS PVRNACES (}AS WATER HEATERS
DUC[5 GAS PIPE OLTtLE'fS
PLUMBIIV(i
BATI-�JBS�or7Ub/s6wuercomeo) SHOWERS WA1�R CIASEIS(�ptky MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OVILETS SUMPS RAINWATER SYST
WASHING MACHINFS URINAIS HOSE BIBBS
IAVS�aw,00m smlmJ VACWM BREAKERS EiECTBIC WATER FiFATERS
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I crrt}fy weder penolty of perJury that the ir4jorneation JurnEshed by me is true nnd oorrect to the beat oj my knn�uledge,and further,that I
am autho►ise�d by the oumer qf the aboue premises to the work for urhich the permtt appltcallon is made. I further agrce to hold
harmless the City qf Pbderal Wtq�as to any cla�m�Irec1 costs,expenaes, and attorneys',fees incun+cd in the i�estipatiton and dqfense qf
such claLN,which mqy 6e made 6y arg�person,i the uriderstgned,and,�iled opainst the Clty qf afedera!Wap,but mily urhere such claim
arls�es out qf the raliance of the city.inc! r�g and employees.upon the accuracy oj the i�}J'ormatinn suppLied to the d!y m a part qf
this appHcatinn.
NAME/TIT1.E DATE /� ������_
I 1 (I7Ue)
RELAITONBI3IP TO PROJECT ❑ Owner ❑Agent Contractor ❑Architect ❑ Other
FOR OFFICE IISE OM.Y
❑NEW ❑ADDI1TONi ❑ALTERATIOPi ❑RFPAIIt o TENANT III�'ROVEMffiiT
B[JII.DING 3AF.II1.ONLY? o YES ❑NO H�ASIC PLABI7 ❑YES ❑If0
ZONII�(i DEaIGNA1TON CHANQE OF USE? ❑YES o 1�f0
NEW ADDRESS R�$UIItED? ❑YE8 ❑li0 UP/SEPA/SII? ❑YES ❑NO
P1.ATTED LOT? ❑YES ❑PO DF.�[O PERMIT RF.gUIILED? ❑YES ❑1�P0
Bulletin#100-January 7,2005 Page 2 of 4 k�i-Iandouts�Permnit Application
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RESIDENTIAL COMMERCIAL
xEw xEsmEi�rr�,s�xvicE x�w co�xc�r.inrnUsrx�L s�xvic�
❑ Single Family Squarc Feet Serutce or Feeder Each Add'n
(First 1300 ft�-$104.50:Each add'n 500 ft�-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or gazage ❑ 101-200 amp 141.00 89.00
(Inspected with scrvlce) $44.00 ❑ 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 6p1-800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMII.Y(three units or more) ❑ Over 1000 aznp 530.50 283.00
Seruice Feeder
❑ Up to 200 amp $1 I3.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
❑ 401 -600 amp 193.00 96.00 ����CIAL/II�iDU3TRIAL
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service orFeeders
❑ 0 to 200 amp $113.50
ALTF.RED 3IIVGI.E/E[L1I.TI FAMII.Y ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Seruice or Feeder ❑ over 1000 amp 443.50
❑ 0 to 200 amp $87.00
❑ 201 -600 amp 141.00 ❑ #of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 circuits-$89.00:Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PI.AN RE\►IEW
(1-4 ctrcutts-$69.50;Add'n circults$7.00/ea) $89.00 plus 3596 of Permit Fee
❑ Service- 1,000 amps or geater
❑ Mast or meter repair $52.00 ❑ Medical/Educarional/Instltutlonal Facility
MOSILE HOMES
❑ Service or feeder only $69.50
❑ Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOI�/RV PARH a�a�t��ia�nity $si.00
❑ #of servlce or feeders
(First service/feeder-$69.50;each add'n-$45.00) Com�nerClal/Lndustrial ServiCe or Pleeder Amp4City
❑ 0-100 amps $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/E$ITIPMENT
❑ #of Thermostats ❑ #of Sigas
(FYrst-$52.00;add'n-$16.00/ea] (First sign-$52.00;add'n sign$24.50/ea)
❑ �W voit�e ` �d� 0 s.�"g n�/�►ar�................ �s�.00
�uare Feet to be served by system(s)� (Includes additional clrcuit,►f required)
PYre Alarm System ❑ Yard Pole meter loops................ $104.50
Secur�ty ntarm system ❑ Additioaal Plan Revle�v ..... $104.50/hour
❑ Voice Cabling (for modlfled submittals)
❑ Data Cabltng
� ❑ Antomatlon Fee on all Permits .. $5.00
(Per S�stem(s)Ia�2500 ft�-$61.00:
Each add'n 2500 ft2-I6.00)•F�r wAC 296-46-91o(5)Ib1K es W
Bulletin#100-January 7,2005 Page 3 of 4 k�iandouts�Permit Application